Claims Review Analyst

Job description

General Summary Supports the system in charge capture, coding accuracy, and claim denials management. Conducts reviews of claim denials and submits appeals. Performs a variety of functions including, but not limited to answering inquiries and researching third party payer policies and coding guidelines to optimize reimbursement for the system while ensuring compliance with applicable laws and regulations. Duties and Responsibilities: Essential Functions: - Consults with departments throughout the system on charge processes. Ensures appropriate use of CPT, HCPCS and ICD-10 codes as well as modifiers. - Conducts reviews comparing medical record documentation to validate charge capture, medical necessity, and coding accuracy. - Investigates and recommends action steps and works collaboratively with the department when coding and/or compliance issues are found. - Identifies denial trends, billing errors, and determines root cause to prevent future denials. - Investigates billing system errors, through help desk tickets and work queues, due to potentially inappropriate documentation, coding, medical necessity or charge entry. Communicates with departments, including Compliance to initia...